I
remind you that any medical information provided in these reports is
just that…information only!! Not medical advice!! I am not your
doctor, and decisions about your health require consultation with
your trusted personal physicians and consultants.

The information I provide you is to empower you with knowledge,
and I have repeatedly asked you to be the team leader for your OWN
healthcare concerns. You should never act on anything you read in
these reports. I have encouraged you to seek the advice of your
physicians regarding health issues. Feel free to share this
information with family and friends, but remind them about this
being informational only. You must be proactive in our current
medical environment.

Don’t settle for a visit to your doctor without them giving
you complete information about your illness, the options for
treatment, care instructions, possible side effects to look for, and
plans for follow up. Be sure the prescriptions you take are accurate
(pharmacies make mistakes) and always take your meds as prescribed.
The more you know, the better your care will be, because your doctor
will sense you are informed and expect more out of them. Always
write down your questions before going for a visit. And see your
doctor at least yearly.

February is Heart Month!! It is a great reminder to get your heart
checked. Make an appointment with your doctor and talk to him or her
about considering an EKG, especially
if you are over 50 years of age. Blood
pressure checks are very important including actual physical
heart examinations by your doctor. As
always, family history will dictate
to some extent the aggressiveness of a cardiac evaluation including
testing for elevated cholesterol, glucose (sugar), and other liver
and kidney tests. Talk to your doctor about being over-weight,
smoking, having hypertension, etc.

Below are some statistics that are important to keep in mind since
cardiovascular disease (CVD) is still the #1
killer of adult Americans. CVD includes
heart disease,
stroke, and
peripheral artery disease (PAD).
The best heart healthy diets are described in the latest best diets
report just mentioned above .

Men develop CVD about 10 years earlier than women is more common
in blacks. Below there are some important facts avout CVD:

Early detection
is critical to prevent permanent injury to the cardiovascular
system. Other tests such as ankle-brachial index, a blood test
called C-reactive protein, and tests for the amount of calcification
in the coronary arteries are not routinely recommended (USPSTF) at
this time, but are used to assess risk.

One of the most controversial issues in prostate cancer is
deciding whether to carefully observe a
cancer and treat it only if it becomes more aggressive or progresses.
This is especially true for older men 75 years of age and older.

Most younger (than 75) men choose standard treatment (surgery or
radiation) for various reasons including the risk of recurrence. It
is known that much younger patients are more likely to have a more
aggressive tumor, however not all are aggressive and some are very
slow growing. Longevity (life
expectancy) comes into play with more senior patients, and it is
easier for them to consider observation.

Doctors can determine the aggressiveness of a cancer using
pathological analysis from
multiple prostate biopsies (called the
Gleason score), plus the PSA level,
and MRI scan results. If a cancer is
localized (inside the capsule of
the prostate, in just one smaller spot), most patients underwent
surgery or radiation if younger in age than 75.

Position of the prostate cancer determines staging.
Note the T-1 cancer is considered localized and not into the
capsule. As the cancer progresses, it invades into the surrounding
structures.

Now a new study has compared radical surgery
with observation
for men 75 and younger. It has
taken time to follow these men (average follow up 12.5 years) over
an extended time to see if the mortality was higher in those
undergoing radical prostatectomy or in those who were observed.
Cancers that started slow but eventually progressed, can still have
definitive treatment and be cured. Guidelines for observation,
repeat biopsies, MRIs, etc. may vary with cancer centers.

Results of the Study

A 20 year study followed 700 men who were randomized to have
either surgery or observation (the option of radiation was not in
the study). Results showed that only 7%
actually died of their prostate cancer in the surgery group
and 11% in the observation group, considered statistically similar.

The all-cause death rates (over
those 20 years) were 61% in the surgery group and 67% in the
observation group, but again the difference was not statistically
significant.

Those who were observed had a higher progression rate of their
cancer as one would expect, but half were asymptomatic and the
cancer progressed only inside the prostate still allowing for
curative surgery. Only 20% of those
initially observed ultimately had surgery and rarely after 5 years.
This saved a large number of men having surgery.

Androgen deprivation therapy is
commonly used to prevent recurrence or suppress the growth of tumors
in the prostate (similar to using
tamoxifen in women with breast cancer).

Androgen
deprivation therapy is an anti-hormone treatment (Lupron, Zolodex,
Trelstar, etc.). It was used twice as often in the observation group
(21% vs 44%) to prevent either progression or recurrence. (Most men
are put on androgen deprivation therapy if the prostate cancer is
more aggressive after surgery or radiation).

There are significant side effects from suppressing androgen in males, and would be
more significant in younger men. This must be part of the discussion
when deciding options for care.

Adverse side effectsfrom surgery were more common in
this study as expected than those that were observed. Allowing
progression of a cancer could cause more obstruction of urine flow.
Erectile dysfunction, rectal issues, and incontinence were the most
common long term side effects in those treated with surgery. These
side effects have to be considered if surgery (radiation) is chosen.

This
study confirms that the risk of dying
from prostate cancer is low and
observation should be an option if
the cancer is localized and fits the criteria for a less aggressive
cancer.

It is critical to consider the parameters discussed in this report
to determine how aggressive a cancer is and whether observation,
surgery or radiation should be considered. The above study did not
compare radiation with observation and a study is needed.

Second opinions are wise when considering all 3 options.

Decisions to make (PSA), observation vs treatment

Death caused by prostate cancer is less than 4% in patients
younger than 75 and even lower if over 75 (they die of unrelated
causes). 80% of prostate cancers are considered to be slow growers
based on pathological analysis and testing.

It is the decision of doctors and patients whether to
screen for prostate cancer with a
PSA test in the first place, and
now there is another decision to make. Now there are 3 options to
consider (observation, surgery, or radiation) at ages younger than
75.

With continued research, hopefully doctors can more effectively
separate low grade from high grade cancers and treat accordingly. As
we continue research on genetic markers, this will likely shed
significant light on this difficult subject.

The pacemaker and defibrillator business is thriving with more
seniors living longer. With greater numbers of devices comes
increasing numbers of infected and
dysfunctional implants.

The overall incidence of infection is
1-4%
in adults (slightly higher than joint replacements), but with
increasing numbers being implanted, the rate of infection is
increasing. 70-80% are implanted in patients 65 years or older. The
inpatient mortality in these patients is 2% because of their
underlying cardiac disease.

Infection in the implant is a ruinous
complication and is more common after a previous replacement.
Infection is the reason for removal and replacement in 70% of the
cases. Replacement of batteries is another reason. Signs of
infection were present with fever and elevated white blood cell
count. Staph, strept, E.coli, and pseudomonas infections have been
reported.

Anyone with an implant who develops a fever for no obvioius reason
must be checked for an infected implanted cardiac device.

The patients requiring these devices are in some degree of cardiac
decompensation (usually some type of serious heart block or
arrhythmia), and these devices are in most cases life-saving.
It is estimated that over 3 million
Americans currently have these implants.

More recently wireless pacemakers
are being used (mostly experimental), which would potentially
prevent having wires directly implanted into the heart muscle thus
eliminating a major source of infection.

Infections can occur along these wires called
vegetations similar to what
occurs on heart valves and can cause heart valve infections as well
(endocarditis). Infections in
the pocket where the implant is placed can also occur but is less
common. The infection creates local damage and seeds the blood
stream with bacteria. A significant percentage will grow bacteria
from blood cultures. These infections usually occurs over the first
year.

Antibiotics are recommended prior to implantation to prevent
infections based on studies from the 1990s.

Removal of the wires is relatively easy during the first year, but
later removal is difficult due to scarring around the wires
necessitating procedures to release the wires from the scar
(commonly lasers are used).

In patients with pacemakers and defibrillators, it is critical for
patients to discuss with their cardiologist about prophylactic
antibiotics when having other operations and dental procedures to
prevent seeding of bacteria into the implants.

It is important for patients to understand the risks and benefits
of any procedure, and this is no exception.

It is critical to be prepared to leave the hospital with all the
correct information to prevent post-hospital complications.

Here are some important questions to ask before leaving:

a) Do you have the correct medication
list with dose and schedule? Are there any new medications
that might interfere with current ones?

Patients and or family members must bring pill bottles, a list of
their medications to the hospital, or call the primary care doctor
for an updated list. If certain meds must be stoped prior to
surgery, be sure those instructions were followed prior to
hospitalizationas they may need to be stopped 7-10 days (stopping
aspirin, Omega 3 fatty acids, anticoagulants, St. John’s wort, etc.)
and ask when to restart them.

c) There is often more than one treating doctor, but it is
important to know that the primary treating doctor knows about these
treatments from all consulting doctors (ask the nurse to check).
Which doctor is responsible for post-hospital instructions, and
which doctor(s) are to be seen after discharge and when?

d) Will any lab tests need to be scheduled post-hospital before
returning to see the doctor(s)? Has the patient been anticoagulated?
Be sure to know any limitations because of this medication.

e) Are there written post-hospital instructions. Do you
understand them? Who is primarily doctor responsible for me after
discharge?

f) Resting in the hospital can be a challenge with vital signs
being taken around the clock. Talk to the nurse about sedatives if
needed for rest and perhaps a prescription after discharge. Weakness
from bedrest, surgery, medications must be addressed. Do you need
home physical or occupational therapy to get back on your feet?

g) Do you need any special supplies after discharge such as a
bedside commode, crutches, anti-embolism stockings, etc.?

h) Ask for a summary of the hospitalization (even if it has be
emailed or mailed), diagnoses, post-hospital management plan,
prescriptions needed to be called to the appropriate pharmacy (have
the phone number), etc.

This information may not be available unless you insist.
Be sure you ask for the least costly
prescriptions, because if you don’t, you may stroke out from the
price. Shamefully, most doctors do not have a clue about the price
of drugs. The squeaky wheel gets oiled!!

i) Who do you call if there is an emergency or there are
questions, and what phone number? If the doctor is in a group, who
is on call for your doctor?

It is still important to note that teens who use e-cigarettes,
hookahs, cigars, and smokeless tobacco are
twice as
likely to start smoking cigarettes within a year. Use of multiple
methods raises the risk to 4 times. E-cigarettes come in many
flavors attractive to children. Do not
let your young people experiment with vapes, e-cigarettes, or
nicotine addicting methods.

Adults and smoking rates/mortality

The number of
adults who smoke is still dropping resulting in a lower mortality
rate from smoking-related cancers dropping 5% since 2005. Most
quitters are age 25 to 44. But there still are
15.5% of adults in the U.S. still
smoking and are disproportionately male, those with
disabilities, no insurance or on Medicaid, the LBGTQ Community, and
those who live in the South and Midwest. CDC Statistics, 2017

90% of those who try to quit smoking do so “cold turkey”. Even
stopping for a day will get a person on the road to quitting. The
American Cancer Society still has a
successful program to stop smoking—The
Great American Smokeout—the third Thursday of November. It
gives potential quitters a target date to pick. Check it out at
www.cancer.org

Status of e-cigarettes

The
British Medical Journal (BMJ), July, 2017, cited 161,000
participants that were studied to find out about their use of
e-cigarettes in trying to stop smoking. Results concluded that since
2014, the number of adult users of
e-cigarettes has increased dramatically. This study included
current smokers (11.5%) and recent quitters (19%) who were current
e-cigarette users. Men were more likely to use e-cigarettes as were
younger age groups.

The results reported that 8% of
e-cigarette users were successful in quitting, whereas only
5% who were trying to stop with other methods (gum, patch, pills)
were successful. This is only one study and needs to be replicated
for the FDA to be convinced. They have postponed deciding approval
til 2020. That usually means insurance will not pay until approved.

The study results may not be very impressive (8 vs 5%), but it
represents just one of the first studies to show the value in
smoking cessation. The low rates of staying off tobacco underscore
the enormous task it is to kick nicotine addiction. But smoke free
environments have helped plus the introduction of quit-smoking aids.

It is interesting that younger people are more successful at
quiting than older people. Users of long time nicotine addiction
takes it toll.

The inserted cartridges in e-cigarettes are available in
decreasing concentrations of nicotine, so people are able to
withdraw from the addicting chemical at their own pace.

Some will stay on a maintenance low concentration of nicotine in
their e-cigarettes for prolonged periods and many will for years to
come. At least they are not inhaling the carcinogens in a cigarette.
The long term effect of continuing to consume nicotine with
e-cigarettes has not been studied.

For those who struggle with smoking cessation, e-cigarettes are
apparently a legitimate method to try, but there still needs to be a
heavy dose of motivation to quit. Relapse is common, so do not be
discouraged.

It is well known
that there is a link between nicotine addiction and depression. It
would stand to reason that smoking cessation is more difficult to
attain in this group.

There are greater symptoms of nicotine withdrawal in depressed
patients. Smoking cessation and depression must both be addressed .
It is twice as likely for depressed
patients to be addicted, and more likely to relapse if the
person tries to quit.

Physicians should ask if there
is concomitant depression in any patient desirous to quit.
Withdrawal symptoms can include using tobacco to relieve or avoid
symptoms which might aggravate depression.

There are 11 symptoms
defined by the Diagnostic and Statistical Manual of Mental Disorders
for any substance abuse (narcotics, alcohol, including tobacco):

The strongest predictors for nicotine
addiction are the time to first cigarette in the day and
total cigarettes per day. Those that start their day with a
cigarette have the hardest time quitting.

New information on best treatments

Nicotine replacement use increases the quit rate by 50-70% at
least initially even though only 5-8% stay quit. In depressed
patients, the use of anti-depressants and counseling is necessary
prior to and during attempts at smoking cessation. The use of the
oral medications are anti-depressants.

Skin patches provide the most constant steady rate of nicotine
into the blood stream and have a higher compliance rate but are not
as successful in relieving some of the cravings.
Using more than one method can be tricky
(because of overdose of nicotine), and guidance from the physician
or smoking cessation counselor is clearly necessary. Using the oral
medication (plus a patch and occasional use of a lozenge is
recommended by MD Anderson Cancer Institute cessation counselors.

There is a new nasal spray (one
to two doses per hour—maximum of 40 doses per 24 hours) available in
addition to the known methods.

This study did not address the addition of bupropion (Wellbutrin,
Zyban) or varenicline (Chantix),
which is an antidepressant and is also successful in assisting
smoking cessation in addition to using nicotine replacement methods.
Adding these medications enhance the quit rate, but there are no
studies yet how much more successful.

Nicotine replacement may be required for 6 months or longer and
may require low dose maintenance therapy for years. Regardless of
techniques, there is a 50% relapse rate for those who quit.

90% of people still go “cold turkey”
when they decide to quit.

Behavioral therapy achieves a
60-100% cessation rate and a one year cessation rate of 20%. Add
exercise to the program, and it is even more successful. Medscape,
Dec., 2017

FYI

Hypnosis and acupuncture are no better than placebo as reported in
recent journal articles (but remember placebos can help as many as
20% of people).

Nicotine addiction is as hard to kick as heroin, because these
chemicals stimulate the same craving centers in the brain.

For best results in kicking the habit, consult your doctor for
oral medication consideration plus at least one nicotine replacement
method, and counseling. With this combined method, you have more
than a 20% chance of staying quit.

We define a patient with cancer as a survivor from the time of
diagnosis to the end of life!!

Today, a good percentage of patients are living for years after
their original diagnosis of cancer enjoying a good quality of life.
Cancer for many can be thought of as a chronic disease. Cancer
survivors in the U.S. will number 20 million by 2026 (15 million in
2016), according to the American Cancer Society. It has been quite a
victory for oncology, patients and families, although we have a long
way to go until we conquer cancer.

Thanks to screening, early diagnosis, and improved treatments,
most cancers can be cured in over 80% of the cases. A third is due
to screening and two-thirds are due to treatment advances according
to the latest data.

There are exceptions to taking a victory lap, because early
diagnosis is not possible in some cancers, and it is because these
cancers do not create early symptoms. Lung, pancreatic and ovarian
cancer are examples. With these particular cancers, there are to
date no cost effective screening methods for the general public
(there are tests for high risk groups). Even some of the screening
methods have been questioned as reliable or do not necessarily need
to be discovered until smptoms occur (i.e. prostate-PSA).

For those who have success in either controlling or curing their
cancer, these patients will experience significant side effects from
their treatment. Most are aware of treatment side effects during the
process, but some of these side effects don’t even show up for
months or years.

I have already discussed chronic fatigue
in cancer survivors (Part 1 of the cancer survivorship series)
in the 54th Medical News Report. Click on the website:

Our enemy is formidable. Two of
biggest fears survivors have is recurrence of the original
(primary) cancer, but they also have an increased risk of a second
cancer separate from the first. This risk is greater than the
general population. Genetically, those that are diagnosed with
cancer are more prone to other cancers even when, there is no known
genetic marker. But even a recurrence or a second independent cancer
is not a death sentence.

Cancers of the respiratory tract have risk factors that increase
the chances of a second respiratory cancer. For example, a smoker
who develops a head and neck cancer has an increased risk of being
diagnosed with lung cancer, but there is also a 15% chance of
developing another separate head and neck cancer especially if they
keep smoking.

According to the JAMA Oncology Journal,
approximately 25% of Americans 65 years and older and 11% of younger
patients who were previously diagnosed with cancer will have one or
more cancers at different sites.

Breast cancer patients with genetic markers (BRCA) at risk for a
second independent cancer in another site in the breast. This has
led many women to undergo a preventative mastectomy in the other
breast. Also, if the cancer is BRCA gene mutation positive, ovarian
cancer risk is 50-65%, with a higher risk of colon cancer than the
general population. More recently if a man has a female family
member with the BRCA gene mutation, it has been discovered they are
more prone to developing prostate and male breast cancer.

Long term surveillance is critical

These are examples of why it is so important to have
intense surveillance for years
after a survivor’s initial treatment. Survivorship guidelines are
critical to follow these patients with a plan. Oncologists are also
reaching out to primary care providers to assist in these
survivorship issues as the number of oncologists is not increasing
to keep pace with our increasing population.

Patients who undergo chemotherapy and or radiation therapy for any
reason have a higher risk of developing leukemia. Therefore, routine
blood counts are critical in following these patients.

Risk reduction and screening plays a critical role in preventing
recurrence and second cancers. These risks vary with the cancer.
Early detection of a recurrence or a second independent cancer will
give the patient the greatest chance of control or cure.

As many as a third of cancer survivors stop seeing their
oncologists within 5 years after treatment. With this knowledge, it
would be prudent to maintain contact with them or a willing primary
care physician who is trained to follow cancer survivors and their
risks. There are training modules for primary care physicians
provided by the George Washington Cancer Institute in cooperation
with the Amercian Cancer Society that I (and a group of dedicated
volunteers) spent 5 years working on thanks to a CDC grant. Here is
the website:
http://www.cancer.org/treatment/survivorshipduringandaftertreatment/index

What can a cancer survivor do to reduce their risks of recurrence or
a second cancer?

Risk reduction is essentially the same as it is for the first
cancer. Aproper diet, weight management, smoking
cessation, less alcohol consumption, sun protection, and exercise
are positive moves to reduce risk. Protected sex, and vaccination
for hepatitis B can also reduce the risk of a HPV or other viral
induced cancers.

It is known we can prevent as much as 50% of cancers with better
lifestyle behaviors, screening, and vaccination. Education is also
the best way to prevent cancer.

Don’t forget the rest of the body

Most importantly, routine
followup for survivors is critical to not only check for recurrence
but new cancers in other areas of the body. Survivors cannot get
tunnel vision for theoir cancer and forget routine screenings and
whole body checkups, as another cancer (and other diseases) can be
diagnosed early and cured. Surveillance is for life!

Great news about progress in cancer of the lung

There is great news about treating
lung cancer. As most know, it is a deadly disease with dismal cure
rates. The most common type is the non-small cell squamous cell
carcinoma. I recently reported on immunotherapy for advanced disease
describing good benefit over the usual chemotherapy. A recent report
cited nivolumab (Opdivo-a check point
inhibitor immunotherapeutic drug with PD-1 expression) has extended
advanced patient’s life span from a 5 year survival rate of 16% to
as high as 43%. This is huge!! This drug is outperforming any
medication for advanced disease in the lung. If you want to read
about immunotherapy, please click on: www.themedicalnewsreport.com
#61 Reference: The American Journal of Clinical Oncology, July, 2016,
The American Cancer Society, The National Cancer Institute; JAMA
Oncology, 2017

Later in the year, I will continue the cancer survivorship
series-part 3-chronic pain in cancer survivors

The mouth is lined with a mucosa that is the same throughout the
gastrointestinal tract and therefore signs may occur in the mouth
implicating a lower GI disease. It is also commonly involved
(sometimes the earliest sign) in skin diseases, and other systemic
diseases.

2-Crohn’s disease—50% present with
some type of oral lesions including diffuse lip, gum, and mucosal
swelling. Fissures at the corner of the mouth (angular cheilitis
shown above) are common. Granulomas can develop in the mouth
appearing as bumps in the mouth.

3-Gastrointestinal Reflux—oral
complications occur in 18-28% of patients with reflux. Acid reflux
back into the mouth at night causes damage to enamel of teeth, sore
throat, a sensation of a lump in the throat from acid irritation
including swallowing difficulty. Treatment with PPIs (proton pump
inhibitors—Prilosec, Prevacid, Dexilant) is necessary to combat the
acid and will improve the symptoms. Dexilant is the best but a tier
4 drug (expensive).

B. Liver Disease

Chronic liver disease usually implies cirrhosis caused by alcohol,
hepatitis, and other toxicities. Frequently because of bleeding
tendency from loss of vitamin K, hemorrhages in the mouth can occur.
Bleeding gums is common. Jaundice will turn the mouth yellow (the
whites of the eyes too). Hepatitis C has a higher incidence of
lichen planus (2-4 fold increase). This skin disease causes papules
and plaques, which can occur in the mouth as well. Lichen planus
often causes these oral manifestations.

C. Medications causing oral cavity issues

a.
Biphosphonates (Fosamax, Didronel,
Zometa, Boniva, Reclast, etc.) for osteoporosis can cause
osteonecrosis of the jaw. Below is an area of exposed bone which is
draining. There is dead bone present which must be removed by an
oral surgeon. Alternatives to treat osteoporosis would also be
appropriate

Monilial (fungal) infection

Antibiotics cause fungal infections in the mouth

The above slide is a monilial (yeast) infections treated with oral
antifungal medications (Nizoril, Diflucan, etc.). Probiotics may
also help if started when antibiotics are begun.

Many drugs can
cause sores in the mouth especially antibiotics and chemotherapy
which can cause fungal overgrowth and extreme soreness, white
patches that may be rubbed off but return.

Chemotherapy or radiation mucositis is very common with certain
chemotherapeutic agents or radiation to the mouth for cancer of the
oral cavity and throat. This must be treated by a knowledgeable
dentist and oncologist with oral rinses, pain medication,
combination mouth washes (magic mouth wash), and liquid diet. It is
extremely painful and unfortunately a common reason patients decide
to stop chemotherapy. Below is a cancer on the edge of the tongue
and severe mucositis on the right slide.

Squamous cell cancer

mucositis

Herpetic gingivostomatitis

Viruses

The above slide
demonstrates small bumps that bust easily and create small ulcers
that are painful. This is herpetic
gingivostomatitis. The herpes virus can cause fever blisters
on the lips but also create multiple ulcers in the mouth and must be
treated with one of the acyclovir oral medications (Zovirax, Valtrex).

This photo above shows the back of the throat with numerous pockets
of pus caused in this case by the
Cocksackie virus, the most common virus caused by hand, foot,
and mouth disease. It usually can last 1- 2 weeks and will resolve
but is very painful. Local non-alcohol containing rinses will help
while they resolve and the so-called “magic mouthwash”, which is a
combination of steroids, antibiotics, anti-fungal agents, etc.

The Cocksackie virus can be confused with infectious mononucleosis
caused by the Ebstein-Barr virus
(photo below left), but usually the tonsils are still present and
involved. It is also confused with strept throat (photo below
right). There is no actual treatment, but liver function studies and
evaluation for an enlarged spleen is necessary. Below is a typical
appearance of mono on the left slide

The above slide demonstrates soreness with mild ulcers in the mouth
that are enlarging with hemorrhages in the mucosa. This is an
example of a skin disease which affects the mouth—pemphigus
vulgaris, which is present in 50-70% of patients.

This “lacey” appearing white plaques could be monilia but in this
case, it is lichen planus, an
immune disease which also affects the skin. The white patches can’t
be rubbed off.

This photo above is a methamphetamine user. Dental decay and
periodonititis are usually severe and will require major dental
rehabilitation. Attractive isn’t it? Cocaine can do similar damage.
Medscape

Recently, the NEJM
(New England Journal of Medicine) Journal Watch reviewed a multitude
of articles in an attempt to answer the question—“Is there any help
for older people in preventing dementia?” The answer is—there is
no magic bullet for this terrible
affliction.

Here is some recent information:

a) Aerobic activity and resistance training helps those with
cognition in normal people but not those already diagnosed.

b) There is no medication (prescription or OTC) that will reverse or
slow down dementia. This includes a long list of off-label
medications, supplements, and vitamins.

c) Cognitive training does not improve cognition in the general
population of those with dementia.

There is intense research in this field, however, we are not there
yet. The mysteries of a degenerative disorder that afflicts an
increasing number of Americans has yet to be unraveled.

There is evidence that a nutritious diet, regular exercise, not
smoking, limiting alcohol, not abusing illegal substances, and
maximizing management of chronic illnesses may help prevent the
onset of dementia in some selected patients, but the amount of time
it takes to prevent dementia is undetermined. It only makes sense
that the healthier a person is, the more likely dementia will be
delayed if it is going to develop.

Annals of Internal Medicine, 2017

This completes the February, 2018 report. Remember, this is Heart
Month!! Be kind to yours!!